FILED

United States Court of Appeals

Tenth Circuit
UNITED STATES COURT OF APPEALS

FOR THE TENTH CIRCUIT

December 21, 2012

Elisabeth A. Shumaker
Clerk of Court

ANDREW T. BLOCK,
Plaintiff-Appellant,
v.
MICHAEL J. ASTRUE, Commissioner,
Social Security Administration,

No. 12-6098
(D.C. No. 5:10-CV-01242-D)
(W.D. Okla.)

Defendant-Appellee.
ORDER AND JUDGMENT*

Before KELLY, OBRIEN, and MATHESON, Circuit Judges.

Andrew T. Block appeals from the district courts order affirming the Social
Security Commissioners denial of his application for supplemental security income
benefits. Mr. Block argues that the Administrative Law Judge (ALJ) (1) failed to
evaluate the medical evidence properly; (2) relied on incompetent vocational expert
(VE) testimony; and (3) erred in his credibility analysis. We independently review

After examining the briefs and appellate record, this panel has determined
unanimously to grant the parties request for a decision on the briefs without oral
argument. See Fed. R. App. P. 34(f); 10th Cir. R. 34.1(G). The case is therefore
ordered submitted without oral argument. This order and judgment is not binding
precedent, except under the doctrines of law of the case, res judicata, and collateral
estoppel. It may be cited, however, for its persuasive value consistent with
Fed. R. App. P. 32.1 and 10th Cir. R. 32.1.

the Commissioners decision to determine whether it is free from legal error and
supported by substantial evidence. Krauser v. Astrue, 638 F.3d 1324, 1326
(10th Cir. 2011). Substantial evidence is such relevant evidence as a reasonable
mind might accept as adequate to support a conclusion. It requires more than a
scintilla, but less than a preponderance. Wall v. Astrue, 561 F.3d 1048, 1052
(10th Cir. 2009) (internal quotation marks omitted). Exercising jurisdiction under
42 U.S.C. 405(g) and 28 U.S.C. 1291, we affirm.
I. BACKGROUND
Mr. Block was 21 years old when he filed for supplemental security income
benefits. He has a high school education and completed job training in residential
and commercial construction. He worked for brief periods as a cook, general
contractor, and landscaper.
Mr. Block filed for benefits in May 2006, alleging he became disabled on
December 15, 2005, due to [m]ental illness, bipolar I disorder, [d]epression
unspecified, . . . herniated disc in center back, right ankle has been broken 4 times,
[and] right leg shorter than left leg. Admin. R. at 200. Benefits were denied
initially and on reconsideration. Mr. Block then requested and received a hearing
before an ALJ. The ALJ issued an unfavorable ruling, finding Mr. Block not
disabled at step four of the five-step sequential evaluation process for determining
disability. See Wall, 561 F.3d at 1052 (describing five steps). The Appeals Council,
however, issued an order vacating the ALJs decision and remanding the case to the
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ALJ for further proceedings, noting that Mr. Block did not have any past relevant
work. See Jozefowicz v. Heckler, 811 F.2d 1352, 1355 (10th Cir. 1987) (defining
past relevant work).
The ALJ held a second hearing and issued a new decision, denying benefits at
step five of the sequential evaluation process. See Wall, 561 F.3d at 1052. The ALJ
found that (1) Mr. Block had not engaged in substantial gainful activity since the date
he filed his application for benefits; (2) he has severe impairments of low back pain,
recurrent right sprained ankle, obesity, bipolar disorder, anxiety disorder, and a
history of alcohol abuse; (3) these impairments, singly or in combination, did not
meet or medically equal any of the per se disabling impairments listed in 20 C.F.R.
Part 404, Subpart P, Appendix 1; (4) he has no past relevant work; and (5) he is
capable of making a successful adjustment to work that exists in significant numbers
in the national economy.
The Appeals Council denied Mr. Blocks request for review, making the
ALJs decision the Commissioners final decision. Krauser, 638 F.3d at 1327.
Mr. Block appealed to this court after the district court adopted the magistrate
judges findings and recommendation to affirm the Commissioners denial of
benefits.

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II. DISCUSSION
A.

Evaluation of the Medical Evidence

Mr. Block challenges the ALJs evaluation of medical source statements from

(1) Dr. Stow, Mr. Blocks treating physician; (2) Kay Ramsey, Mr. Blocks mental
health counselor and case manager; and (3) both Ms. Ramsey and her supervisor,
Lynn Denslaw, a licensed clinical social worker.
1.

Dr. Stow

In Dr. Stows March 2008 Medical Source Statement-Physical (MSS-P), he

checked boxes indicating Mr. Block could lift and/or carry 10 pounds, stand and/or
walk 1 hour in an 8-hour workday with usual breaks, and stand and/or walk for
30 minutes continuously. He also checked boxes indicating Mr. Block could sit for
30 minutes continuously and for a total of 1 hour in an 8-hour workday with usual
breaks. Dr. Stow noted that Mr. Blocks ability to push and/or pull was limited
because he was wearing a right ankle brace and was unable to flex/extend his right
ankle. Dr. Stow further indicated that Mr. Block could frequently handle, finger and
feel; could never climb, balance, stoop, kneel, crouch, crawl or reach; and that he
needed to avoid heights. In answer to the question Briefly describe in what ways
the impaired activities . . . are limited, Dr. Stow stated that Mr. Block has a bad
ankle, [b]ack pain due to herniated discs, [s]evere anxiety, and [h]eadaches.
Admin. R. at 480.

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Mr. Block argues that the ALJ did not adequately consider Dr. Stows opinion.
According to Mr. Block, the limitations identified in Dr. Stows MSS-P are supported
by medical evidence from doctors other than Dr. Stow. In his words, the medical
evidence of record shows [he] was treated for right ankle pain and back pain by
medical health providers other than Dr. Stow and the evidence supports that he
has . . . significant back and right ankle impairments that result in significant
limitations. Aplt. Br. at 13. Mr. Block also faults the ALJ for assigning little
weight to Dr. Stows MSS-P, contending that the ALJ did so without addressing the
factors for weighing opinion evidence. See 20 C.F.R. 416.927(c). Mr. Blocks
arguments are unavailing.
When analyzing a treating physicians opinion, the ALJ first considers
whether the opinion is well supported by medically acceptable clinical and
laboratory diagnostic techniques and is consistent with the other substantial evidence
in the record. Pisciotta v. Astrue, 500 F.3d 1074, 1077 (10th Cir. 2007). If so, the
ALJ must give the opinion controlling weight. Id. But if the ALJ decides the
treating physicians opinion is not entitled to controlling weight, the ALJ must then
consider whether the opinion should be rejected altogether or assigned some lesser
weight. Id. Relevant factors for weighing opinion evidence include:
(1) the length of the treatment relationship and the frequency of
examination; (2) the nature and extent of the treatment relationship,
including the treatment provided and the kind of examination or testing
performed; (3) the degree to which the physicians opinion is supported
by relevant evidence; (4) consistency between the opinion and the
record as a whole; (5) whether or not the physician is a specialist in the
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area upon which an opinion is rendered; and (6) other factors brought to
the ALJs attention which tend to support or contradict the opinion.
Watkins v. Barnhart, 350 F.3d 1297, 1301 (10th Cir. 2003) (internal quotation marks
omitted). See also 20 C.F.R. 416.927(c) (factors for weighing opinion evidence).
Before evaluating Dr. Stows opinion, the ALJ described the medical evidence
provided by other physicians. See Admin. R. at 14-16. This is the same evidence
Mr. Block cites in support of his contention that he has significant back and right
ankle impairments that result in significant limitations. Aplt. Br. at 13. We
summarize that evidence here.
Mr. Blocks history of back pain began in March 2003. Admin. R. at 302-05.
In February 2005, Mr. Block fell and sprained his right ankle. Id. at 293-97. In June
2005, about a week after reinjuring his right ankle, physical examination revealed
excessive inversion of the ankle but x-rays were normal. Id. at 279. Mr. Block was
diagnosed with recurrent ankle sprain. Id. In July 2006, a physical consultative
examiner made a similar diagnosis: [c]hronic sprain of the right ankle (neglected).
Id. at 314. In evaluating Mr. Block, the consultative examiner observed Mr. Blocks
gait without an ankle brace and reported that it was steady, stable, and secure without
any assistive devices. Id. The consultative examiner also found that Mr. Block had
pain on inversion of the right ankle and tenderness over the right lateral malleolus,
but both ankles ranges of motion were within normal limits and there was no
evidence of synovitis or arthritis in any joints examined. Id.

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In August 2007, a physician examined Mr. Block for bilateral back pain. Id. at
442-45. Mr. Block reported a history of disc problems in his lower back, but had no
recent injuries. Id. at 442. Mr. Blocks back examination revealed negative straight
leg raising bilaterally and pain at about 50 degrees on the left. Id. at 444. In March
2008, Dr. Stow completed the MSS-P at issue. Id. at 479-80. In February 2009, after
a car accident, Mr. Blocks chest x-rays were normal, id. at 492, as was a cervical
spine series, id. at 493. X-rays of Mr. Blocks thoracic spine showed mild
levoscoliosis, but no acute abnormality, id. at 494, and he was diagnosed with
cervical/thoracic strain secondary to a motor vehicle accident, id. at 487. Several
days after the car accident, Dr. Stow examined Mr. Block. Dr. Stows examination
revealed Mr. Block was stiff and sore in the neck, tender to palpation, and his
shoulder range of motion was decreased. Id. at 528. Dr. Stow reported that
Mr. Blocks [m]usculoskeletal system is normal. Gait is normal. Id. Dr. Stow
diagnosed Mr. Block with a neck sprain. Id.
Turning to Dr. Stows MSS-P, the ALJ concluded: While Dr. Stows opinion
regarding the claimants limitations is probative and has been given due
consideration, . . . the medical opinion is not substantiated by the clinical findings
and is inconsistent with the other evidence of record. Id. at 18. In support, and
contrary to Mr. Blocks position, the ALJ cited inconsistencies between Dr. Stows
opinion and other substantial evidence in the record.

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For example, in contrast to the physical limitations described in Dr. Stows

MSS-P, Mr. Blocks July 2006 physical consultative exam revealed that he had full
strength in his extremities; normal ranges of motion in both ankles; and that his gait
was steady, stable, and secure without any assistive devices. The ALJ also noted that
Mr. Block had neglected the chronic sprain of the right ankle and had not followed
up with medical care from his treating physician. Id. See Decker v. Chater, 86 F.3d
953, 955 (10th Cir. 1996) (The failure to follow prescribed treatment is a legitimate
consideration in evaluating the validity of an alleged impairment.). Further,
although Dr. Stow indicated in the MSS-P that Mr. Block had back pain due to
herniated discsand Mr. Block testified he is disabled due to back painMr. Block
did not allege back pain during his physical consultative exam. The ALJ went on to
note that after Mr. Block was involved in the 2009 car accident, he had a normal
cervical spine x-ray series and his thoracic spine x-rays showed mild levoscoliosis,
but no acute abnormality. Thus, the ALJ decided to give[] little weight to the
opinions and findings of Dr. Stow where they [we]re not supported by the signs,
symptoms and medical findings of record. Id. at 18.
We discern no error. Our review of the record confirms that the ALJs
decision not to give controlling weight to Dr. Stows opinion is supported by
substantial evidence.
Further, in evaluating what weight to assign Dr. Stows opinion, the ALJ
properly considered the degree to which Dr. Stows opinion was supported by
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relevant evidence and the consistency between Dr. Stows opinion and the record as a
whole. See 20 C.F.R. 416.927(c) (factors for weighing opinion evidence). The
ALJs summary of the medical evidence also made clear that Dr. Stows treatment of
Mr. Block was relatively infrequent. See id.1 It is not necessary for the ALJ to
address each factor for weighing opinion evidence expressly or at length. See
Oldham v. Astrue, 509 F.3d 1254, 1258 (10th Cir. 2007) (observing that not every
factor for weighing opinion evidence will apply in every case) (alteration and
internal quotation marks omitted). What matters is that the decision is sufficiently
specific to make clear to any subsequent reviewer[] the weight the adjudicator gave
to the . . . opinion and the reasons for that weight. Id. (internal quotation marks
omitted). The ALJs decision meets this test.
2.

Kay Ramsey and Lynn Denslaw

In Ms. Ramseys February 2008 Medical Source Statement-Mental (MSS-M),

she checked boxes indicating Mr. Block had marked limitations in the ability to carry
out detailed instructions; maintain attention and concentration for extended periods;

Thus, despite Mr. Blocks insistence that Dr. Stow examined him on
numerous occasions from 2004 to 2010, Mr. Block cites treatment notes from
seven office visits for conditions largely unrelated to back and right ankle pain. Aplt.
Br. at 12. See Admin. R. at 281 (ear pain and blurred vision); id. at 285 (same); id. at
474 (lump under right breast), id. at 470-73 (vomiting blood), id. at 528 (sprained
neck), id. at 525 (cyst removal), id. at 526 (cyst in groin area). Moreover, we note
that Dr. Stow left question E on the MSS-P blank. It reads: Briefly describe the
principal, clinical and laboratory findings and symptoms or allegations (including
pain) from which the impairment-related capacities and limitations
indicated . . . were concluded. Id. at 480.
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perform activities within a schedule, maintain regular attendance and be punctual;

work in coordination with or proximity to others without being distracted by them;
make simple work-related decisions; and complete a normal work day and workweek
without psychologically based symptoms, and perform at a consistent pace without
an unreasonable number and length of rest periods. Ms. Ramsey also checked boxes
indicating marked limitations in most areas of social interaction. See Admin. R.
at 482-83. In January 2010, a second MSS-M was completed and signed by both
Ms. Ramsey and Ms. Denslaw. It is nearly identical to the first MSS-M. Compare
id., with id. at 529-30.
Mr. Block acknowledges that under the Social Security regulations
Ms. Ramsey and Ms. Denslaw are not acceptable medical sources, that neither
can be considered a treating sourc[e], Aplt. Br. at 18-19, and that they cannot
provide a medical opinion or medical evidence establishing the existence of a
medically determinable impairment. See Frantz v. Astrue, 509 F.3d 1299, 1301-02
(10th Cir. 2007). Instead, they are classified as other sources whose opinions can
be considered to show the severity of the individuals impairment(s) and how it
affects the individuals ability to function. Soc. Sec. Ruling (SSR) 06-03p,
2006 WL 2329939, at *2 (Aug. 9, 2006).
Mr. Block argues that the ALJ did not adequately consider Ms. Ramseys and
Ms. Denslaws mental medical source statements, broadly asserting that the ALJ did
not follow the analysis contemplated by SSR 06-03p or Frantz. We disagree.
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In Frantz, we explained that SSR 06-03p was promulgated to clarify how the
agency considers opinions, like those of Ms. Ramsey and Ms. Denslaw, from
sources who are not acceptable medical sources. Frantz, 509 F.3d at 1301 (internal
quotation marks omitted). The same factors for weighing the opinions of acceptable
medical sources, see 20 C.F.R. 416.927(c), apply . . . to all opinions from medical
sources who are not acceptable medical sources, Frantz, 509 F.3d at 1302.
Additionally, the ALJ is required to explain the amount of weight he assigns a
particular opinion:
[T]he adjudicator generally should explain the weight given to opinions
from these other sources, or otherwise ensure that the discussion of
the evidence in the determination or decision allows a claimant or
subsequent reviewer to follow the adjudicators reasoning, when such
opinions may have an effect on the outcome of the case.
SSR 0603p, 2006 WL 2329939, at *6. In the case of a nonacceptable medical
source . . . , the ALJs decision is sufficient if it permits us to follow the
adjudicators reasoning. Keyes-Zachary v. Astrue, 695 F.3d 1156, 1164 (10th Cir.
2012) (quoting SSR 0603p, 2006 WL 2329939, at *6)).
Here, the ALJ thoroughly detailed the contents of a July 2006 mental
consultative exam, see Admin. R. at 14-15, and treatment notes from the clinic where
Ms. Ramsey acted as Mr. Blocks case manager, see id. 15-16. Then, as to the first
MSS-M, the ALJ concluded:
A case manager is not an acceptable medical source to provide medical
evidence of the claimants impairment. She is not certified or licensed
psychologist . . . . Furthermore, the[] marked limitations [identified] are
not consistent with the medical evidence of record, including
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[Ms. Ramseys] own reports and the psychiatrists reports at Red Rock
Behavioral Health.
. . . Ms. Ramseys opinion is given little weight.
Id. at 18-19. Turning to the second MSS-M, the ALJ noted that a social worker is not
an acceptable medical source and assigned the opinion the same weight as the first
MSS-M. Id. at 19.
In assigning little weight to the mental medical source statements, the ALJ
observed that Mr. Block
has continued medication management at Red Rock Clinic. He attended
almost all of his scheduled appointments. . . . [He] was medically
compliant most of the time and he reported no side effects. His speech
is normal, mood is normal, and thought is oriented times three. He has
no psychotic process such as delusions or hallucinations. His
interaction is cooperative. His sleep is decreased. . . . He claimed he
was doing okay. A few times he reported having depressive symptoms
and his medications were adjusted. . . . [He was] reported [to have] a
drug seeking tendency with the benzo.
Id. at 18-19.
As mentioned above, Mr. Block asserts that, in assigning little weight to the
mental medical source statements, the ALJ did not follow the analysis contemplated
by SSR 06-03p and Frantz. Yet he does not specifically address how the ALJ
allegedly failed in this respect. Mr. Block states that he had a long treating
relationship with Ms. Ramsey. He urges, without detail, that her treating notes are
consistent with her mental medical source statements. Mr. Block asserts that
Ms. Denslaw was familiar with his treatment. And he complains that the only other
assessment of his mental abilities was from a psychological consultative examiner.
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As best we can discern, Mr. Block would like us to engage in an impermissible

reweighing of the evidence and to substitute our judgment for that of the
Commissioner, an invitation we must decline, Hackett v. Barnhart, 395 F.3d 1168,
1173 (10th Cir. 2005).
In any event, the ALJ explained the weight he gave the mental medical source
statements: little. And the ALJs discussion of the evidence permits us to follow
his reasoning. As such, the ALJs decision on this point is satisfactory under our
precedent. See Keyes-Zachary, 695 F.3d at 1164.
B.

The Vocational Experts Testimony

At step five of the sequential analysis, the ALJ asked a VE whether Mr. Block

might be capable of performing entry-level work in the regional and national

economy. As reflected in the hearing transcript, the ALJ asked the VE to assume a
hypothetical person who, among other things, [c]ant interact appropriately with
others at a superficial level, but not the general public, and cant adapt to a work
situation . . . . Admin. R. at 49 (emphasis added). In the ALJs written decision,
however, as part of Mr. Blocks residual functional capacity (RFC), the ALJ stated
that Mr. Block can interact appropriately with others at a superficial level, but not to
include the general public. He can adapt to a work situation. Id. at 12 (bold text
omitted) (emphasis added).
Mr. Block asserts that the difference between the ALJs use of cant at the
hearing and the ALJs use of can in his written decision, in conjunction with the
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illogical VE response to the ALJs . . . hypothetical . . . does not constitute

substantial evidence sufficient to support a denial of benefits. Aplt. Br. at 24. The
Commissioner counters that the transcriber inaccurately transcribed cant and the
VEs testimony provided substantial evidence to support the ALJs decision. In
support, the Commissioner points out that counsel for Mr. Block was present at the
hearing but did not mention the VEs allegedly illogical response to the ALJs
hypothetical; that counsel did not raise the issue before the Appeals Council; and that
the hearing transcript was not created until after the Appeals Council denied
Mr. Blocks request for review, see 42 U.S.C. 405(g) (As part of the
Commissioners answer [to claimants civil action challenging the denial of benefits]
the Commissioner of Social Security shall file a certified copy of the transcript of the
record.).
Having reviewed the hearing testimony in its entirety and the administrative
record as a whole, we agree with the Commissioner that the presence of cant in
the hearing transcript must have been a transcription error. To conclude otherwise
would be tantamount to ignoring the VEs testimony, which was responsive to an
inquiry about a hypothetical person who can interact appropriately with others at a
superficial level, but not the general public, and who can adapt to a work situation.
The VE testified that the hypothetical person described by the ALJ could work as a
(1) price stamper, Dictionary of Occupational Titles (DOT) code 209.587-034;
(2) laundry sorter, DOT code 361.687-014; and (3) folding and inserting machine
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operator, DOT code 208.685-014. See Admin. R. at 49-51.2 Further, [c]ant interact
appropriately with others at a superficial level, is incongruent with but not the
general public. Id. at 49 (emphasis added).
Accordingly, we reject Mr. Blocks contention that the vocational evidence
was incompetent. The VEs testimony demonstrates that he heard the ALJ say can.
The ALJ, who asked the question at the hearing and relied on his memory (and
perhaps an audio recording of the hearing, but not a transcript, see 42 U.S.C.
405(g)), used the word can in his written decision. Indeed, even Mr. Block
concedes that a typographical error may have occurred. Id. at 25.
C.

Credibility Analysis
The ALJ found Mr. Blocks statements concerning the intensity, persistence

and limiting effects of his symptoms not credible to the extent they were inconsistent
with his RFC. Mr. Block challenges this determination in the last 2 pages of his
brief on appeal, contending the ALJ improperly evaluated Mr. Blocks allegations of
pain and based his determination on mistaken observations from the medical record.
Credibility determinations are peculiarly the province of the finder of fact,
and we will not upset such determinations when supported by substantial evidence.
However, findings as to credibility should be closely and affirmatively linked to
substantial evidence and not just a conclusion in the guise of findings. Hackett,
395 F.3d at 1173 (citation, brackets, and internal quotation marks omitted).
2

The ALJ relied on this testimony in concluding Mr. Block was not disabled.
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The ALJ cited a number of grounds, tied to the evidence, for his adverse
credibility finding. The ALJ found (1) Mr. Block alleged disability due to lower
back pain but did not complain about back pain at a consultative physical exam;
(2) there was no showing of nerve root compression or radiculopathies requiring
invasive treatments or a showing that he required extensive physical therapy or other
conservative treatment; (3) he had not demonstrated considerable loss of motion or
muscle strength; (4) his gait was reported to be steady, stable, and secure without any
assistive devices; (5) he had not received ongoing medical treatment for either of his
allegedly disabling physical impairmentsback and right ankle pain; and (6) there
have been significant periods of time since the alleged onset date during which
Mr. Block has not taken any medications for his alleged pain.
Our review of the record convinces us that substantial evidence supports the
ALJs credibility determination.
III. CONCLUSION
For the foregoing reasons, we affirm the judgment of the district court.

Entered for the Court

Scott M. Matheson, Jr.

Circuit Judge

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